GW1-2021-02715_Well Construction - GW1_20210527

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WELL CONSTRUCTION RECORD l=ortr�rmltlsc©Ntv: a
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t.Vi'dlCnnttytctor.infOt�Iatlon: i
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Zach Thompson VROM 0 IpnoN
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VROM To nTAI%ft?TI:R TnitKdrM MATt;ttIAL
SABDACCO Inc 0 R. 8 IL 2" le. SCH-40 PVC
Compsttry Nam 76.1' yfll; IAl24fMr<itritit ... #..:.
FROM OLMIFTrU TniCKh'£55 I MATERIAL
2.Wcil{Con.shvtxbtn Permlt#: 70002677 h. ft.
Lim o t npplimme Weft permits toe.Cnxruy,Slime,bnrldwe.I*criot ex.)
tt. ft. in.
3.Wdl 1)sc(t:hodCwdi asc): s
Water$n{Il/ty Well: PROM 170t n DTitTR StATr StLY TIII4YC SFCS ]HATYR7A1
ClAgxicitlnital �.lVlilDlttilk7ltihtbiic 8 ft. 28 ft 2" In! 0.010 SCH-40 PVC
DGMthenna.1(Heating ooling-Supply) DResidential Water 5gppt,(single)
Dindusttial/Cotntltercial 01tesidentiai Water Supply(shared) FROM 170 MATERIAL EM1dC3 AtECT MrMOD A utaouvr
131rfigolion 0 R. 4 ft. Portland Cankutection
Nan-Water Supply Well: R, tt
IlMonitorin altecoveTy
Injection well:
0 Aquifer RccltaTe' DGroundvm ter Rcattediatian
VROM AIATRR14AL Ir?MYLA &1t rY nn
DAquifer Stowe find Recaml 13salirtityeflincr 6 11.- 28 ff. Filtered Sand #2
0AA*,fcrTea OStommRttdDrairta a R,
O>_glcnmcnttal Technology gSrdlsidencc t onfroi
illt1ti11Nfl= ` G tik>wf#iNltoa9atls3fa+ecctcsa z-777
DGeothernial(Closed Loop) DTraca TRost I TO ouscRtrnov a»i bran att+thnck rtGt
DGeodien alWeati ? 0' Retvm DOdter in under#21Rernatt) 0 ft. 28, ft. Tan/Brown Silt
A. M
t.Date WO(s)Completed: 5/4/2021 AVdI M#MK-16 '
ft. fi:
Sa.Wi4llarcartinn: ft. tr
Wilson Air Center (L R. 1 L^°
Faet7ii)i'C R-MrNarne FecHih•tD#efapptieablef
5414 Airport Rd., Charlotte, NC, 28208 R B,
Pksiml Adsi—City.and Zip 2ir; MINA7".7-�.,77-r.eZzina
Mecklenburg Bentonite Seal from 4'-6' JVT�CD
eftfo- ParrdtdemlttentionNo,{p 1)
15h.1*10ide and t onthude in(legtee.slmimrtestsecrinds or dedroal 4COVM 22,Ccrtifkstion:
{it�rr 111ieM,tr+rs 101ars is s+dlie{tte)
35.208724 N -80.929658 W 5/8/2021
SIg0 t M 0rCdIWvd WdI C0=s:tof Dade
6..ts(arc)the nell(s): 2 FermmAnent or DTemporary t .3io s chit fbt>rr.?&rrbp.,trt{/i+that the+i rlpsl uas{fir(cx+ntrrurted nr wevnimee
4rh l5A NCAC 02C,01W or ISA NCAC 02C4209 Motl Comftef m Srdndmds and Owra
7.Ls thb a repair to an existing well: oVes or ENo ropy ofthir mrord 4"been prorwe'd ro i.*; rll ouvw,
tf this is o repair.All mr Axft a urli coatsrrralmr lommw4w and exprain At wrare of the
repnir under 071 maarb owdim ar.oRn the b®rt of rats form. 21 Site diagram or additional well details:
You:may use the hack of tWs page;to pto ide additional mil site details or y ell
S.Number of wells cottmmeted: 1 comnuctian details. You may also attach additional pages if necessary.
For ntmWe 1 rtke rm or"7is srAWy itylb ONIX"id)the amne roorAry rlon.yen amIN�331C1Y©N$
9.Total welt depth hebolt°bod sulihee: 28 (R,) Z4s. For A[t Wells. Subs t this:form vt�ithin 30 ties of ootnpWorr of well
fhb tartrrrrfriple xxtls)Jsf ail i?iln#r i{cliff rem(erar,tw 3 3(#t►'rrnul2k�ifJdY) construction to follouin
10.Stalk water Icvel below top of caslnd: (it,) Divtsinn of Water Resourw,lofnfinstidn Processing Unit,
tf i,vdrrr kvet 1r above cddfj$,use`4 16171VUit Service Ceni x Rylelgh.ETC 276"-1617
t 1.Borehole diameter:a.25 0 (ia) 34b.For tnicetlnn Visits ON Y:f In addition to-sending ttte fat'm to the addrms in
24o above-also submit a copy of this form vrlthin 30 days of completion of tvtll
12.Well conshvetion t mAbod:Bored oonstnlaian to the follotitittg:
(Le.arrprr,rotsry,able:dingy flrtA cte:)
Dlvhlon of Water'R.esources;•IIitderground Injection Control Pro9mm,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Semite C'entI m Raleigh.NC 1 6994636
133.Veld(gpm) Method of test 2tt.For Water SoWl&In[acttaii.Wells:
Also silbnnt one ecyl}°of this form mithfn;30 ftsof completion of
13b.Disinfection tyTie Anent: pICII ctod. ' k h dc{ar n=#of the county'what
Ntl1 constnrctioia to the count} hcait
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